Leptospirosis Flashcards
Etiology of leptospirosis
Spirochetes, Leptospira interrogans, highly motile
Most important reservoir of leptospirosis
Rats
L.interrogans serovar Copenhageni
Phase when organisms proliferate, cross tissue barriers, disseminate hematogenously to different organs
Leptospiremic phase
+ Blood culture
Phase when antibodies appeare and coincides with the disappearance of leptospires
Immune phase
+ Urine culture
Leptospira virulence factor
loa22
Incubation period
1-2 weeks
Triad of Weil’s syndrome
Hemorrhage
Jaundice
AKI
Presentation of leptospiral nephropathy
Urinary losses of magnesium
Cardiac findings which are poor prognostic signs
repolrization abnormalities
arrhythmias
Long-term sequela of leptospirosis
Autoimmune uveitis
Definitive diagnosis
Gold standard: Culture and isolation (6-8 weeks for result)
PCR-can confirm the dx in the first 5 days
Indirect method:
MAT(1:1600 is diagnostic)
Treatment for mild lepto
Doxycycline or Amoxicillin or Ampicillin
Moderate to Severe Lepto treatment
Penicillin or Ceftriaxone or Cefotaxime or Doxycycline
Clinical manifestations should alert a health practitioner to suspect leptospirosis among patients presenting with acute fever?
acute febrile illness of at least 2 days
AND either residing in a flooded area or has high-risk exposure
AND presenting with at least two of the following symptoms: myalgia, calf tenderness, conjunctival suffusion, chills, abdominal pain, headache, jaundice, or oliguria should be considered a suspected leptospirosis case
Pre-exposure prophylaxis
Doxycycline (hydrochloride and hyclate) 200 mg once weekly, to begin 1 to 2 days before exposure and continued throughout the period of exposure
Post exposure prophylaxis for low risk
Doxycycline 200 mg single dose within 24 to 72 hours from exposure
Post exposure prophylaxis for moderate risk
Doxycycline 200 mg once daily for 3-5 days to be started immediately within 24 to 72 hours from exposure
Post exposure prophylaxis for high risk
Doxycycline 200 mg once weekly until the end of exposure
Clinical features of AKI due to leptospirosis
mild proteinuria to severe anuric acute renal failure
Commonly it may present as non-oliguric renal failure with mild hypokalemia
Oliguria with hyperkalemia may reflect the severity of AKI and may connote poor prognosis
Indications for acute renal replacement therapy or dialysis
Any one of the following
a. Uremic symptoms – Nausea, vomiting, altered mental status, seizure, coma
b. Serum creatinine > 3mg /dL
c. Serum K > 5 meq /L in an oliguric patient
d. ARDS, pulmonary hemorrhage
e. pH < 7.2
f. Fluid overload
g. Oliguria despite measures following the algorithm
First sign of pulmonary involvement
Tachypnea
Pulmonary symptoms appear
4th-6th day
MC pulmo complications of lepto
Pulmo hemorrhage
ARDS
